Ozgur Turkmenoglu

Granulomatous Mastitis: Clinical, Pathological Features, and Management

Abstract:  This clinical study was conducted to present clinical, radiologic, and histopathologic features of Granulomatous Mastitis (GM) and evaluate the result of surgical and steroid treatment. Sixteen cases diagnosed histologically as GM were reviewed. Patient characteristics, clinical presentation, radiologic imaging, microbiologic, histopathologic assessment, treatment modalities, recurrence, morbidity, and follow‐up data were analyzed. Majority of the patients were child bearing age and all of the patients had a history of breast feeding. Radiologic findings were nonspecific. Histopathology showed the characteristic distribution of granulomatous inflammation in all cases. In 12 cases, surgical excision of the lesion with negative margins was performed. Four cases required quadranectomy because of wideness of the disease. Three patients who had local reoccurrence and three resistant patients were treated by oral prednisone after surgical attempt. Complete remission was obtained and no further recurrence was observed in this patients. GM predominantly occurs in premenopausal women and the clinical symptoms might be misjudged as breast cancer. Histopathologic examination remains the gold standard for the diagnosis. Wide excision of the lesions is the recommended therapy and we suggest steroid therapy in resistant or recurrent disease following the idea that the disease has an autoimmune component.

A prospective randomized comparison of single-port laparoscopic procedure with open and standard 3-port laparoscopic procedures in the treatment of acute appendicitis.

Background: This prospective randomized study aimed to evaluate the surgical outcomes of single-incision laparoscopic appendectomy (SILA) comparing with open appendectomy (OA) and standard 3-port laparoscopic appendectomy (SLA) in the treatment of acute appendicitis (AA). Methods: Adult patients older than 18 years presenting with AA were randomized into 3 groups to undergo OA, SLA, and SILA from September 2010 to May 2011. The groups were compared with regard of patient’s characteristics, perioperative findings/complications, operative time, pain severity, analgesic requirement, time to oral tolerance and flatus, length of hospital stay, and cosmetic results. Results: A total of 75 consecutive patients enrolled in the study. Each group included 25 patients. The groups showed no significant differences in patient’s characteristics. The mean operative time was significantly longer in SILA than OA with a mean difference of 7 minutes (P<0.05). Postoperative pain after OA were significantly higher than SLA and SILA (P<0.05). The average time to oral tolerance and flatus was significantly higher in OA than the laparoscopic groups with a mean difference of 1 and 2.5 hours (P=0.04 and 0.023, respectively). The length of hospital stay in SLA and SILA was significantly lower than OA with a mean difference of 0.8 days (P<0.05). There was no difference in overall complications between the groups. There was no difference between SLA and SILA in terms of surgical outcomes. Conclusions: Either SLA or SILA offer patients faster recovery period with acceptable complications than OA. Hence, laparoscopic approach might be considered as first option in the treatment of AA. However, all 3 techniques provide equivalent clinical outcomes despite the significant findings. Therefore, technique selection is based on surgeon’s decision, experience, and availability of laparoscopic instruments.

Drainage after total thyroidectomy or lobectomy for benign thyroidal disorders

ObjectiveThis prospective randomized clinical trial was conducted to evaluate the necessity of drainage after total thyroidectomy or lobectomy for benign thyroidal disorders.MethodsA total of 116 patients who underwent total thyroidectomy or lobectomy for benign thyroidal disorders were randomly allocated to be drained or not. Operative and postoperative outcomes including operating time, postoperative pain assessed by visual analogue scale (VAS), total amount of intramuscular analgesic administration, hospital stay, complications, necessity for re-operation and satisfaction of patients were all assessed.ResultsThe mean operating time was similar between two groups (the drained and non-drained groups). The mean VAS score was found to be significantly low in the non-drained group patients in postoperative day (POD) 0 and POD 1. The mean amount of intramuscular analgesic requirement was significantly less in the non-drained group. One case of hematoma, two cases of seroma and three cases of transient hypoparathyroidism occurred in the non-drained group, whereas one case of hematoma, two cases of seroma, two cases of wound infections and two cases of transient hypoparathyroidism occurred in the drained group. No patient needed re-operation for any complication. The mean hospital stay was significantly shorter and the satisfaction of patients was superior in the non-drained group.ConclusionThese findings suggest that postoperative complications cannot be prevented by using drains after total thyroidectomy or lobectomy for benign thyroid disorders. Furthermore, the use of drains may increase postoperative pain and the analgesic requirement, and prolong the hospital stay. In the light of these findings, the routine use of drains might not be necessary after thyroid surgery for benign disorders.

Phenol procedure for pilonidal sinus disease and risk factors for treatment failure

BACKGROUND The present study was designed to evaluate the results of phenolization for pilonidal sinus disease and the risk factors for treatment failure. METHODS Between June 2005 and July 2009, 76 consecutive patients with nonrecurrent sacrococcygeal pilonidal sinus were treated with a phenol treatment and included in the study. The clinical (age, sex, story of treatment for abscess formation, and comorbidity), operative (localization and number of sinus openings and volume of cavity), and follow-up data (healing time, time off work, postoperative complications, morbidity, and number of phenolization sessions) of the patients was recorded. Gender, age, history of abscess drainage, number of sinus openings, localization of sinus openings, volume of cavity, and the number of phenolization sessions were analyzed as risk factors for treatment failure. RESULTS The overall success rate was 67% (51 of 76 patients). The mean time to complete healing was 16 days (range, 10-45). The time off work was 0 days. Age and gender were not found to be risk factors for treatment failure (P > .05 and P > .05, respectively). Patients with a history of abscess drainage and more than 3 sinus openings had a significantly higher risk of treatment failure (P = .001 and P = .046, respectively). There was no difference between the localization of sinus openings and treatment failure (P > .05). There were statistically significant differences between treatment failure and both the cavity volume and number of phenolization sessions (P = .016 and P = .001, respectively). Patients were followed up for a mean period of 25 months (range, 13-48). One patient (2%) showed recurrence. CONCLUSION With an early return to work and low rates of complications and recurrence, phenolization is a simple outpatient procedure for the treatment of pilonidal sinus disease in selected patients.

Gluteal V-Y advancement fasciocutaneous flap for treatment of chronic pilonidal sinus disease

Although pilonidal disease is quite common, controversy still exists about the treatment. The procedure should cure the patient, and allow speedy resumption of normal activities by reducing pain and disability. This retrospective study was conducted to evaluate our experience with the V-Y fasciocutaneous advancement flap and to review current publications about flap surgery for the treatment of sacrococcygeal pilonidal sinus. We describe the application of the fasciocutaneous V-Y advancement flap for reconstruction of defects after radical excision of recurrent pilonidal sinus in 11 cases. Primary and uneventful wound healing was achieved in all patients but two who developed minor wound breakdown. Large defects after excision can easily be closed using the V-Y advancement flap. This type of flap closure in selected cases offers tension-free, recurrence-free, and reliable skin coverage while flattening the natal cleft that predisposes to recurrences. Reliable flap closure reduces hospital stay, costs, as well as disability and time spent off work.

Effects of trapidil on the healing of colonic anastomoses in an experimental rat model.

Background:  Trapidil has various properties including vasodilatation, inhibition of lipid peroxidation and platelet aggregation as well as, and reduction of, the inflammatory response to injury. The aim of the present study was to investigate the effects of trapidil on dexamethasone‐impaired colonic anastomotic healing in an experimental rat model.

A Randomized Clinical Study Evaluating the Need for Drainage After Limberg Flap for Pilonidal Sinus

BACKGROUND This prospective randomized clinical study was conducted to evaluate the need for drainage after rhomboid excision and a Limberg flap (RELIF) for the treatment of pilonidal sinus. METHODS One hundred one patients undergoing the RELIF procedure were randomly treated with drainage or not. Operating time, postoperative pain assessed on a visual analogue scale (VAS), total amount of intramuscular analgesic administered, hospital stay, complications, recurrence rate, and patient satisfaction were assessed. RESULTS The mean operating time (P = 0.036), VAS scores on postoperative day 0 (P = 0.039) and day 1 (P = 0.006), intramuscular analgesic requirement (P = 0.009), mean amount of intramuscular analgesic administered (P = 0.025), complication rate (P = 0.027), and mean hospital stay (P = 0.0001) were significantly reduced in the non-drained group. The recurrence rate was similar in the two groups (P = 0.32). CONCLUSIONS This study indicates that drain placement after the RELIF procedure might negatively affect the postoperative outcomes of patients with pilonidal sinus. On the basis of these finding, we suggest that the use of drains may not be necessary after the RELIF procedure for the treatment of pilonidal sinus.

Effect of Trapidil in Ischemia/Reperfusion Injury on Rat Small Intestine

To investigate the effect of trapidil on the intestinal ischemia-reperfusion injury, we determined malondialdehyde levels as a indicator of lipid peroxidation, nitrite and nitrate levels as reflections of nitric oxide metabolism, and histopathological findings in rats subjected to 40 min of ischemia and 2 h of reperfusion. Histopathological evaluation demonstrated that trapidil treatment has a protective effect on intestinal mucosa and reduces inflammatory cell infiltration in lamina propria, which is consistently noted in the untreated ischemic and reperfused intestines. Possible mechanism of this effect may be explained by the reduced lipid peroxidation (mean malondialdehyde level 3.72 - 0.27 vs. 6.13 - 0.44, p < .0001) and improved nitric oxide metabolism (mean nitrite plus nitrate 38.21 - 2.33 vs. 30.14 - 1.47, p = .022).

Level IIb lymph node metastasis in thyroid papillary carcinoma

The objective of the study was to evaluate the incidence of level IIb lymph node metastases in neck dissections for thyroid papillary carcinoma (TPC) patients. 47 neck dissections of 33 patients with TPC were prospectively evaluated. Selective neck dissections (levels II, III, IV, and V) were performed in all cases. If level I lymph node metastasis was suspected during the procedure, level I dissection was also performed. All level IIb specimens were sent separately from the remainder of the neck dissection for the pathological examination. The number of dissected and metastatic lymph nodes in each specimen was recorded. Twenty-two of 47 neck dissections (46.8%) were positive for the lymph node metastasis. Among 47 neck dissection specimens, the incidence of lymph node metastasis at level II was 12.7% (6 of 47) and level IIb was 2.1% (1 of 47). The rate of level IIb lymph node involvement among patients with metastatic cervical lymph nodes was 4.5% (1 of 22). The specimen with metastatic lymph node at level IIb had also metastasis at levels IIa, III, IV, and V. The results of the present study suggested that lymph node metastases in level IIb are rare in patients with TPC undergoing neck dissection.

Colonic anastomosis leakage related to taenia saginata infestation

A 49-year-old male patient was admitted to our emer-gency service with a one-week history of abdominal pain.Despite using analgesics, abdominal discomfort progressedto generalized abdominal pain, nausea and vomiting. Uponphysical examination, generalized abdominal tendernessand rebound tenderness were detected. Laboratory para-meters revealed leukocytosis [14.3 6103/ml (range 4.5-11)]and a high C-reactive protein level of 247.12 mg/l (range,5). No disorder was determined from other parameters.Plain x-ray abdominal radiography was unremarkable.Abdominal ultrasonography (US) and computerized tomo-graphy (CT) revealed dilated small intestines in the rightlower abdominal quadrant with pericecal free fluid that wascompatible with a possible perforated or plastron appendi-citis (Fig. 1). Urgent surgery was planned after obtaining thepatient’s consent. On exploratory laparotomy, a complicatedmass formation composed of the appendix, cecum andsigmoid colon was identified in the right lower abdominalquadrant. After separation of the sigmoid colon, a perfo-rated cecal area of necrosis and the appendix wereidentified. A right hemicolectomy and a hand-sewnileotransversostomy were performed. On the third post-operative day, the patient’s vital signs began to deteriorateand an enteric fistula was observed at the drainage tube.Therefore, a second-look laparotomy was performed. Onexploration, an anastomotic leakage associated with asegment of the tapeworm was identified (Fig. 2). Theanastomosis was ligated, and an end ileostomy wasperformed due to the generalized fecal peritonitis. Thepostoperative course was uneventful. The patient received asingle dose of niclosamide (46500 mg) 10 days after surgery.The histopathologic examination of the specimen was read